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Phillip R. Devore, DDS

Phillip R. Devore, DDS, is a graduate of the UCLA Dental School and is currently a private practice consultant and Dental Director for Futuredontics, Inc., operators of the 1-800-DENTIST® cooperative advertising program. Dr. Devore retired from his multi-million dollar practice at age 36 and continues to lecture at the University of California, Los Angeles (UCLA) and University of Oklahoma dental schools.

Digest This:
Commentary on a Recent Consumer Special Report

This guy walks into your office and tells you he's new in town. He recently completed periodontal surgery, so he has a brand new full mouth set of x-rays with him and he wants a complete exam with an estimate for necessary treatment. Sounds good, right? Maybe not. This guy could be William Ecenbarger, an investigative writer for Reader's Digest. He recently saw 50 dentists in 28 states and the District of Columbia to see how many different treatment plans would be elaborated. The results, as reported in the February 1997 issue, were not flattering to the dental profession.

Mr. Ecenbarger initially visited his own dentist, "a man I trust," who did a clinical exam and concluded that he was fine but for the need of a crown on tooth number 30, estimated at about $500. The writer then had a panel of dentists (which he referred to as distinguished) including Dr. John Dodes, the dental expert for the National Council Against Health Fraud, assess his condition. His panel agreed that his oral health was good and all that was necessary was a crown on number 30, plus possibly a crown on number 18.

After this preliminary review of his clinical situation, the writer then hit the road and saw dentists all across the country. He reported that 15 of the 50 dentists who examined him missed tooth number 30 entirely, and three stated he needed no treatment whatsoever. At the other end of the spectrum, a number of dentists told him he needed full mouth reconstruction due to the fact that the periodontal surgery had uncovered his closed but nevertheless exposed margins. Those fees ranged up to $30,000. His visit to a dental school at Creighton resulted in a third year dental student diagnosing #30 and possibly #18.

The author even mentioned The Profitable Dentist Newsletter. Mr. Ecenbarger was apparently shocked to find that "there's a whole business devoted to telling dentists how to build up the million dollar practice." He was surprised to find that dentists actually run their practices like businesses and are interested in being successful at it. He also noted that the average income in 1994 for dentists, $117,610, was not near the poverty line.

This article has triggered an irate response from many dentists, and has been labeled "irresponsible" by the ADA. While the author's motives and methods can be debated, and this reaction by the dental community is justifiable and understandable, I believe Mr. Ecenbarger's article raises some issues that we need to consider.

A major concern for us all is that, according to the author, only 21 of the 50 dentists did an oral cancer screen and only 14 did a periodontal screening. Both are, of course, considered standard of care. To me, it is very upsetting that Mr. Ecenbarger claims one dentist looked at his mouth and said "your dental work is lousy." If this is accurate, it's as bad as failing to diagnose treatment -- it creates doubt in the patient's mind as to the quality of the previous care (and dentistry in general), and in this particular case it was clearly unjustified.

What conclusions can be drawn from this article? First of all, it's a reminder of how critical it is to be mindful of what we say to patients, in particular with regard to fellow practitioners. It also underscores the crucial importance of multiple treatment plans presented at a subsequent visit. Only one of the practitioners mentioned in the article gave a secondary treatment plan, with all the others offering only one option. Dentistry is not an exact science and the art of it includes tailoring the treatment plan to the patient. That is where secondary and tertiary treatment plans come into play. Failure to provide these alternative treatment plans and to offer them at the proper time are in large part responsible for the confusion that resulted which was consequently presented in this article.

The key to success in case presentation, in my experience, lies not only in excellent diagnosis and treatment planning, but also in the presentation itself. According to Earl Estep, a patient is a stranger on the first visit, but a friend on the second. Therefore, for maximum patient understanding and treatment plan acceptance, only information gathering should be accomplished at the initial presentation to the office. Case presentation and information delivery must be saved for the second visit when the patient is considerably more receptive to the information and to you, and more likely to accept recommendation. This also allows the practitioner more time to create options for the patient that may be more valid for this individual than the ideal treatment plan.

The presentation of multiple treatment plans would have resolved the writer's considerations regarding over-treatment, because if each dentist had given a tertiary treatment plan it would probably have been #30 and #18. This would have made dentistry look a whole lot more consistent to the author and consequently a lot better to the public. Most importantly, it would have given the patient the option to choose a treatment plan more consistent with his or her current needs.

It has been said that any publicity is good publicity. Dentists should use this increased consumer scrutiny to reassure their patients that they are in good hands. It provides you an opportunity to strengthen your patients' faith in you as a dentist.

I urge you to read the February 1997 article in Reader's Digest entitled "How Honest Are Dentists?" William Ecenbarger has done us all a favor by pointing out the remarkable inconsistencies across the board within our profession. This doesn't mean that the dentists who performed these examinations were bad dentists. It simply indicates that they did not offer options to this patient, when options were clearly available. As a consequence, he misunderstood the communication he received. If we strive to give our patients staged treatment plan options, we can retain our patients for the long term and all prosper.


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